Comparative Study in Locally Advanced Breast Cancer Treated with Either Cyclophosphamide, Adriamycin, 5-Flourouracil Regimen or Adriamycin, Cyclophosphamide Followed by Paclitaxel

Introduction:Carcinoma breast is the leading cause of death among the cancer patients worldwide. Carcinoma breast is not a single entity but spectrum of diseases. Aims and objectives:This is a prospective two arm comparative study of toxicity and quality of life in patients of locally advanced breast cancer treated with either cyclophosphamide, Adriamycin, 5-flourouracil regimen or Adriamycin, cyclophosphamide followed by paclitaxel.Materials and methods:The study is a prospective randomized two arm study conducted in department of radiotherapy, For a period of 2 years on breast cancer patients treated divided as Patients in CAF (ARM-A) received cyclophosphamide 600mg/m2, Adriamycin 60mg/m2, 5-flourouracil 600mg/m2 as intravenous infusion on day 1 and repeated every 3 weekly for 6 cycles. Patients in ARM-B received cyclophosphamide 600mg/m2, Adriamycin 60mg/m2, as IV infusion every 3 weekly for 4 cycles followed by paclitaxel 175mg/m2 every 3 weekly for 4 cycles. Pre-medication include Ondansetron 8mg , dexamethasone 8mg intravenous push and pantoprazole 40 mg as intravenous infusion.Results:The maximum incidence was observed between 41-50yrs of age in both arms.The most common presentation was postmenopausal status 46.6% in CAF arm and 36.6% in TAC arm. Most common stage of presentation was stage IIIA , 55% in CAF and 48.3% in TAC arm. 75% patients in CAF arm and 63% patients in TAC arm were ER positive.Complete clinical response after neoadjuvant chemotherapy was seen more in TAC arm (16.6%). Among all toxicities alopecia was significant statistically. Peripheral neuropathy was higher in TAC arm. Diarrhea was higher in CAF arm. Nausea and vomiting were similar in both arms. Better quality of life was seen in TAC arm patients.Conclusion: Neoadjuvant chemotherapy integrated into a multimodality program is the established treatment in LABC. Paclitaxel based regimen showed significant increase in complete clinical response of tumor